Mariken Stegmann

‐ Consider adding a qualitative component when performing an RCT or other quantitative research. ‐ Ask the recruiting health care professionals about barriers to recruitment, and explicitly discuss several key issues: (1) if they will perceive a barrier to asking their patients to participate in research; (2) the risk of forgetting the research project because of the low frequency of eligible patients; (3) competition with other research projects; and (4) concerns about the desirability or feasibility of the intervention. ‐ Be proactive and engage in regular contact with health care providers, even if they do not think this is necessary. Try to avoid creating extra meetings by joining routine ones that the clinician already attends. Care practice ‐ To ensure patient ‐ centered care, primary and secondary care must work closely together. Health care providers in both areas should therefore write any correspondence with the needs of the receiver in mind. Regular contact can also ensure that each party remains aware of the patient’s goals and treatments. ‐ Treatment goals should be explicitly discussed with all patients and documented in the patient record and correspondence. Discussions should occur not only after diagnosis but also repeatedly as the disease evolves and new decisions need to be made. ‐ Before making a treatment decision, the patient should be afforded a time ‐ out period for reflection. This could be achieved by adjusting the waiting time standards of hospitals. In this period, the GP should be informed and empowered to support the patient. Education ‐ This thesis has generated new knowledge about the desired content of correspondence for patients with cancer. It is advisable that these findings be implemented in the vocational training of new health care providers. ‐ Other research has shown that training oncologists in SDM improved its practice. 20 Such training should be added to all vocational training in primary and secondary care. Delivering the training as an educational program in a multidisciplinary setting could also teach new health care providers to collaborate better in the SDM process. ‐ Patient recruitment for research should be implemented as an educational topic to the vocational training courses of newly qualified health care providers in both primary and secondary care. Conclusion This thesis has outlined and presented the results for two studies. The OPTion study showed that an OPT ‐ guided conversation did not increase patient empowerment. However, we did show the importance of talking about treatment goals to help patients make treatment decisions and of discussing goals repeatedly over time because they can change. In the PION study, we showed that referral letters should be very concise, but that specialist letters should contain more detail about the full range of treatment options. This can enable the GP to talk with their patients about treatment choices. Thus, the results of both studies add valuable knowledge that can be used to facilitate SDM and deliver health care that is truly patient ‐ centered. 116 Chapter 8